Mixed Medicines: Health and Culture in French Colonial Cambodia by Sokhieng Au (review)

In many ways, Cambodia was considered the backwater of French Indochina. It was often sidelined in colonial budgets, and French doctors and bureaucrats would do their best to avoid a station there. This marginalization is reflected in historical scholarship where Cambodia remains largely a footnote in the history of neighboring Vietnam. Cambodia, however, takes central stage in Sokhieng Au’s important and engaging study on the history of medical encounters during the colonial period. Beyond its geographical focus, Mixed Medicines represents a major contribution to our understanding of the dynamics of colonial rule, the social history of medicine, and the history of modern Southeast Asia.

The book approaches the study of medicine in French colonial Cambodia through a framework of “cultural insolubility” which Au defines as “differing epistemologies in French and Khmer cultures surrounding medicine and disease. These epistemologies underlie the social definition of disease, which in part determines its appropriate treatment” (157). According to Au, French and Khmer medicine can best be understood as distinct cultural systems that, despite undergoing powerful transformations during the colonial period, neither effectively hybridized nor displaced one another. Rather than frame her study in terms of simple exchanges or conflicts between two modes of medicine, one indigenous, the other western, Au uses a broadly interdisciplinary approach “to understand the process whereby vastly different cultures interacted and attempted to negotiate with and understand each other, the epistemological wrangling that resulted, and the wider social implications of the interface between Western medicine and Cambodian society” (7).

Mixed Medicines traces the development of the colonial health service in Cambodia, focusing on the period from 1907 to 1940. From the history of the search for a plague vaccine to the challenges of confronting epidemic disease, Au underscores how the local expansion of Western medicine was shaped as much by rivalries internal to the colonial state as it was by the emergence of new international scientific networks. Doctors, for example, were not just representatives of the colonial administration but also experts concerned with establishing the bounds of their own professional autonomy in ways that did not always neatly align with colonial imperatives.

As the book unfolds, Au demonstrates how French doctors depended on public cooperation and understanding, rather than force and bribery, to achieve their goals. Yet efforts to change indigenous understandings of health (and, by extension, health behaviors) would have to contend with “pre-existing and equally convincing epistemologies of health and disease” (118). Au shows how French doctors were often hamstringed in their efforts to introduce more flexibility and accommodation into the colonial system; efforts to localize Western medicine were blocked by the medical administration while attempts to recruit indigenous medical providers were thwarted by the local population.

By situating the local encounters of French and Cambodian medicine within broader shifts in metropolitan politics, Au exposes how pro-natalist policies and concerns over social medicine from France were “dropped” into colonial Cambodia (134). But rather than simply describe French failures to achieve more broad-based change, she explains the limited popularity of French medical care in terms of the “disjuncture between French intent and Khmer perception” (9). In what has become a common trope in histories of colonial medicine, indigenous responses to Western medicine are typically framed in terms of resistance. Here, Au interprets Khmer reactions as derived from a set of particular experiences, resisting medical procedures not because they were imposed but because they made little cultural sense (81). This is true for Cambodia as much as it is for France and helps to explain, for example, the paradox of Khmer rejection of French doctors while demanding access to (some) Western pharmaceuticals.

Studying the history of medicine as a process of cultural interaction represents a novel approach, and alone makes Mixed Medicines an important read, but it also seems to confirm much of what we already know about the...